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PubMed1996

Malaria control and fever management in Henan Province, China, 1992.

Henan Province, which once had the highest malaria prevalence in China, had only 318 reported cases in 1992. Our purpose was to investigate this late 'consolidation phase' of malaria control in Henan with reference to malaria surveillance. We conducted a questionnaire survey of village doctors in Shang Shi Qiao Township during the transmission period of 1992. Of the 732 recorded fever cases, 16 were probable malaria cases by clinical and treatment response criteria, but only one received a full course of antimalarials. Of the 732 patients, 61% had fever every day, 37% went for treatment the first day, 52% waited 2-3 days and 10% waited longer. One hundred and twenty-eight patients took self-medication before seeing the doctor. Blood examination was carried out in 526 (71%) fever cases but only four were positive, all for Plasmodium vivax. Our findings highlight problems relating to patient behaviour and motivation of village doctors, malaria treatment, surveillance and microscopy, rural migration, economic development and malaria transmission. All need to be considered for reforming the malaria control strategy in Henan Province.

Adolescent↗
PubMed2000

International multi-centre evaluation of a dipstick assay for human leptospirosis.

A dipstick assay for the detection of Leptospira-specific immunoglobulin M (IgM) antibodies in human sera was evaluated in 27 laboratories in 23 countries. 873 serum samples from 711 patients including 329 laboratory-confirmed leptospirosis case patients, 239 noncase patients and 69 patients with viral infections causing heamorrhagic fever were tested. Relative to the results of the reference leptospirosis test, the sensitivity of the dipstick assay was 84.5% for serum samples collected during the first 10 days of the disease and 92.1% for serum samples collected 10-30 days after the onset of disease. The specificity was 87.5% and 94.4%, respectively. Similar to viral haemorrhagic fevers, leptospirosis may cause bleeding. A small number of serum samples from patients with haemorrhagic viral infections gave a weak (1 +) stain. All other samples were negative. In conclusion, the dipstick assay is sensitive and specific and reacts well with serum samples from patients infected with a range of leptospiral strains. It is also easy to use and does not require special equipment or refrigeration. Therefore the assay is ideal for use in developing countries and rural settings.

Antibodies, Bacterial↗
PubMed1987

Food intake and energy expenditure of Nigerian female students.

Twenty apparently healthy and normal Nigerian female students, resident at the University of Ibadan campus, were studied for seven consecutive days to assess their food energy intake and energy expenditure during sedentary and physical activities. The mean age (years) of the group was 20.05 (SD 3.44, range 16-29), mean height (m) 1.62 (SD 0.07, range 1.47-1.74) and body-weight (kg) 51.28 (SD 3.21, range 46-58). The food intake of each subject was obtained by direct weighing, and the energy value determined using a ballistic bomb calorimeter. Daily activities were recorded and the energy cost of representative activities was determined by indirect calorimetry. Activities mainly involved sitting, mean (min/d) 354 (SD 84, range 253-475). Personal domestic activities took a mean of 162 (SD 73) min/d. Sleeping took a mean of 451 (SD 62) min/d. The mean energy intake of the group was 8480 (SD 1316) kJ/d or 167 (SD 30.6) kJ/kg body-weight per d. This value is lower than that recommended by the Food and Agriculture Organization/World Health Organization (FAO/WHO) (1973) as the energy requirement for adult women engaged in light activities (9205 kJ/d), but it is higher than the FAO/WHO/United Nations University (UNU) (1985) recommended value of 8326 kJ (1990 kcal)/d for a housewife in an affluent society. It is lower than the recommended intake of 9350 kJ/d for rural women in developing countries (FAO/WHO/UNU, 1985). The mean energy expenditure (kJ/d) of the female subjects was 6865 (SD 214, range 6519-7222). Mean energy expenditure was lower than mean energy intake. The energy intake and expenditure values indicated that the subjects participating in the present study were not physically very active. It is suggested, for health reasons, that they might undertake more physical activity.

Adolescent↗
PubMed1991

A rapid latex agglutination test for detection of antibodies in tuberculosis and Hansen's disease.

Antigens of Mycobacterium w, a saprophytic fast growing organism having antigenic epitopes cross-reactive with Mycobacterium leprae and Mycobacterium tuberculosis, were coated on to latex beads (0.33 micron Zn size), and the reactivity tested with sera of tuberculosis and Hansen's disease (HD) patients. Seventy nine percent of lepromatous leprosy (LL) and eighty five percent of pulmonary tuberculosis (TB) patients sera showed an agglutination reaction easily read by naked eye. Specificity of the test was further checked by testing sera of non-mycobacterial infection cases and all of them were found negative. Among apparently healthy controls, 4.3% were found positive from non-endemic and 8.8% from endemic area. The sensitivity of the assay is further enhanced from 78.7% to 90.4% and 85.7% to 91.6% in both LL HD and pulmonary tuberculosis respectively, by using immune complexes extracted from the patients sera. Potential of these antigen coated beads to detect the two major human mycobacterial disease, LL HD and pulmonary TB was also put evidence in a double blind study on coded sera samples obtained from various hospitals in India. The antigen coated beads are stable for upto 6 months at 4 degrees C. The latex slide agglutination test reported here, is simple, rapid, easy to perform and can be used even in rural areas of developing countries.

Antibodies, Bacterial↗
PubMed2006

Retained nitrate, hydrated sulfates, and carbonaceous mass in federal reference method fine particulate matter for six eastern U.S. cities.

Material balance of fine particulate matter (PM2.5) measured with the Federal Reference Method (FRM) is developed for one rural and five urban locations in the eastern half of the United States using routine Speciation Trends Network (STN) and FRM chemical measurements and thermodynamic models. The Aerosol Inorganics Model is used to estimate retained particle bound water, and an ammonium nitrate evaporation model is used to estimate nitrate concentrations retained on the Teflon-membrane filter of the FRM. To address large uncertainties in carbonaceous mass calculated from STN carbon measurements, retained carbonaceous mass is derived by material balance between PM2.5 FRM mass and estimates of its non-carbon constituents. The resulting sulfate, adjusted nitrate, derived water, inferred carbonaceous material balance approach (SANDWICH) is compared with reconstructed fine mass (RCFM) using the Interagency Monitoring of Protected Visual Environments monitoring program equation. For this study, the SANDWICH method resulted in approximately 21-27% higher sulfate mass and approximately 24-85% lower nitrate mass. The combined mass associated with sulfates and nitrates, however, are well within +/- 10% of the proportion derived using the more traditional RCFM method. The discrepancies between SANDWICH and measurement-derived carbonaceous mass vary from -21% to +56% on an annual basis and are attributed in part to urban-rural source influences and uncertainties in estimating FRM-retained carbonaceous mass.

Air Pollutants↗
PubMed2007

Death of a G-6-P-D deficient child with co-morbid HIV infection linked to scarification.

Facial scarification is a process of engraving marks on selected portions of the face at infanthood for various cultural purposes. It is a common cultural practice in Africa especially Nigeria. The induction is associated with fever and severe crying in infants. Usage of the same unsterile tools for the induction in different children and the unhygienic environment are possible means of contracting HIV infection. Occurence of G-6-P-D deficiency and malaria predipose to severe anaemia often requiring blood transfusion. Blood screening facilities are grossly lacking in most rural areas in developing countries. This report is on a 2-year-old male child who presented with facial marks, lacked G-6-P-D and died of HIV infection after a follow-up of 6 months. We suggest that HIV infection contracted from facial scarification in the presence of G-6-P-D deficiency caused the child's death.

Body Modification, Non-Therapeutic↗
PubMed2006

Empirical evidence for symbiotic medical education: a comparative analysis of community and tertiary-based programmes.

BACKGROUND: Flinders University has developed the Parallel Rural Community Curriculum (PRCC), a full year clinical curriculum based in rural general practice in South Australia. The examination performance of students on this course has been shown to be higher than that of their tertiary hospital-based peers. AIM: To compare the learning experiences of students in the community-based programme with those of students in the tertiary hospital in order to explain these improved academic outcomes. METHOD: A case study was undertaken, using an interpretivist perspective, with 3 structured interviews carried out over 2 academic years with each of 6 students from the community-based programme and 16 students from the tertiary hospital. The taped interviews were transcribed and analysed thematically using NUD*IST software. RESULTS: The community-based programme was successful in immersing the students in the clinical environment in a meaningful way. Four key themes were found in the data. These represented clear differences between the experiences of the community-based and hospital-based students. These differences involved: the value that students perceived they were given by supervising doctors and their patients; the extent to which the student's presence realised a synergy between the work of the university and the health service; opportunities for students to meet the aspirations of both the community and government policy, and opportunities for students to learn how professional expectations can mesh with their own personal values. CONCLUSION: This study has provided empirical evidence for the importance of the concept of symbiosis in understanding quality in medical education.

Attitude of Health Personnel↗
PubMed2005

Does it make sense to do repeated surveys?--the Lundby Study, 1947-1997.

OBJECTIVE: To describe the Lundby Study and the difficulties in doing repeated surveys. METHOD: Best-estimate consensus diagnoses have been used since 1957 together with DSM-IV and ICD-10 in 1997. RESULTS: The Lundby population consisting of 3563 probands was investigated in 1947, 1957 and 1972. Sufficient information was available for 98-99%. In 1997-2000 a fourth field investigation was carried out. Attrition rate for the interviews was 13% (238/1797). About 36% (1030/2827) had died between 1972 and 1997, but data from registers, case notes and key-informants for the period 1972 and 1997 completed the information for 94% (2659/2827). The population has followed the same pattern of development as many rural populations in Sweden since the 1940s. Multiple sources of information are preferable in longitudinal studies in order to tackle the problem of changing diagnostic systems. CONCLUSION: Low attrition rates over 50 years and reasonable diagnostic uniformity make comparisons over time justifiable.

Aged↗
PubMed2004

Disinfection of contaminated water by using solar irradiation.

Contaminated water causes an estimated 6 to 60 billion cases of gastrointestinal illness annually. The majority of these cases occur in rural areas of developing nations where the water supply remains polluted and adequate sanitation is unavailable. A portable, low-cost, and low-maintenance solar unit to disinfect unpotable water has been designed and tested. The solar disinfection unit was tested with both river water and partially processed water from two wastewater treatment plants. In less than 30 min in midday sunlight, the unit eradicated more than 4 log10 U (99.99%) of bacteria contained in highly contaminated water samples. The solar disinfection unit has been field tested by Centro Panamericano de Ingenieria Sanitaria y Ciencias del Ambiente in Lima, Peru. At moderate light intensity, the solar disinfection unit was capable of reducing the bacterial load in a controlled contaminated water sample by 4 log10 U and disinfected approximately 1 liter of water in 30 min.

Colony Count, Microbial↗
PubMed1999

Development and evaluation of a rapid dipstick assay for serodiagnosis of acute human brucellosis.

A dipstick assay for the detection of brucella-specific immunoglobulin M antibodies was evaluated with 707 sera from 247 laboratory-confirmed brucellosis patients and 342 control sera from brucellosis-free individuals. These sera were collected from six different countries. The assay was found to be highly sensitive and specific. In addition, the test is easy to use and does not require specialized training or equipment, and the components are stable without a requirement for refrigeration. All of these factors make the test ideal for developing countries and rural settings.

Acute Disease↗
PubMed1978

The Arden grating test of visual function: a preliminary study of its practicability and application in a rural community in north-west Iran.

In a preliminary study involving 75 normal and 10 abnormal eyes the Arden grating acuity test was assessed under difficult conditions of rural field work. It was found to be adequately sensitive and specific for screening out individuals with visual impairment due to refractive errors or ocular disease, and to distinguish between these. Inexperienced paramedical personnel could carry out the test satisfactorily with no difficulty and with a minimum of training. In spite of the unusually distracting conditions under which the test was carried out 95% of the subjects tested performed satisfactorily. The results of this preliminary study suggest that the Arden grating test is a valuable tool for screening large populations in rural areas of developing countries.

Adolescent↗
PubMedDate not supplied

A self-administered device for cervical cancer screening in northeast Thailand.

OBJECTIVE: To test a self-scraping device as a mass screening device against a routine scraping method and to evaluate the acceptance of the self-scraping device by a group of rural females from Northeast Thailand. STUDY DESIGN: From a rural area of Northeast Thailand, 552 women were trained and motivated, through primary health care structures, to participate in a cervical cancer screening exercise using a self-scraping device. After one week, the same females were reexamined by gynecologists using the routine scraping method. In both cases the specimens were stained according to Papanicolaou. Through questionnaires the acceptance of the self-scraping device was evaluated. RESULTS: Through the self-scraping method, 13 cases suspicious for malignancy were detected. Specimens obtained through examination by physicians confirmed 11 cases to be suspicious for malignancy. No false negative cases were found. In the detection of inflammation, the self-scraping method was not as accurate as examination by a physician. The device was accepted by the females who participated in the study. CONCLUSION: In the rural areas of developing countries, where physicians and other trained medical personnel are not often available to carry out regular screening tests on a population basis, the self-scraping method can be applied as an integral part of primary health care for mass screening for uterine cervical cancer.

Adult↗
PubMed2006

Weaning foods and their impact on child-feeding practices among low-income Nigerian mothers.

BACKGROUND: Many children in rural communities of developing countries die of nutrition-related causes due to lack of nutrition education and low purchasing power of the families, which result in low-quality weaning foods and poor feeding practices. OBJECTIVE: To evaluate the nutritional composition of local weaning foods and their impact on child feeding practices among low-income Nigerian mothers. METHODS: A cross-sectional survey was conducted between March and June 2005 among 294 randomly selected pairs of nursing mothers and their children who attended the postnatal clinic of State Specialist Hospital and Comprehensive Health Centers in Akure community, Ondo State, Nigeria. A structured, self-or interviewer-administered questionnaire was used to collect information on infant demographic characteristics, feeding, and socioeconomic characteristics of the parents. The children's weights were recorded, and samples of the weaning foods were analyzed. RESULTS: The mothers' ages ranged from 22 to 37 years, and the children's from one to 12 months. Among the parents, two-fifths of the respondents worked as drivers, mechanics, carpenters, and the like, while the remaining respondents were civil servants, health professionals, teachers, merchants, and housewives. The educational attainment of the parents ranged from no formal education (1.4%) to higher education (46%); 13% had completed primary school, and 39.6% had completed secondary school. The average monthly family income was between 3,500 and 30,000 naira (US dollar 23.3-dollar 200). Among the children, 58.3% were of normal weight, 41.1% were mildly underweight, 0.3% moderately underweight, and 0.3% severely underweight; 23.1% were exclusively breastfed, 9.5% received breastmilk and traditional medicinal herbs, 15.6% received breastmilk and commercial weaning food, 7.4% received commercial weaning food only, 14.8% received local weaning foods only, 24.1% received local weaning foods plus breastmilk, and 5.8% received the family diet. CONCLUSIONS: We found that a high proportion of the nursing mothers used local ingredients to formulate weaning foods for their babies. The nutritional compositions of these foods is of high quality and are suitable as weaning foods, particularly for infants of low-income parents who do not have access to commercial weaning foods.

Adult↗
PubMedDate not supplied

Asbestos in the sputum, crackles in the lungs, and radiologic changes in women exposed to asbestos.

In a rural community in South Africa historically exposed to asbestos environmentally and occupationally, 200 women who had worked with asbestos and applied for medical examination to determine compensable asbestos disease were evaluated. Clinical and radiologic evaluation, sputum collection, and microscopic analysis were done. A questionnaire elicited type of exposure, duration, decade of first work exposure, and environmental exposure. Crackles were present in the lungs of 166 women and asbestos fibers and ferruginous bodies were present in 122. Asbestosis was identified in 26 and plural plaques in 62. Auscultation for crackles (rales) is useful in the initial examination of former asbestos workers in rural communities of developing countries.

Age Distribution↗
PubMed2003

Breast cancer screening beliefs by practice location.

BACKGROUND: This study examines variations in breast cancer screening among primary care clinicians by geographic location of clinical practice. METHODS: A cross-sectional survey design was used to examine approaches to breast cancer screening among physicians, nurse practitioners, and physician assistants involved in primary care practice. A summary index of beliefs about breast cancer screening was created by summing the total number of responses in agreement with each of four survey items; values for this summary variable ranged between zero and four. Respondents were classified into urban, rural and suburban categories based upon practise location. RESULTS: Among the 428 respondents, agreement with "correct" responses ranged from 50% to 71% for the individual survey items; overall, half agreed with three or more of the four breast cancer screening items. While no significant differences were noted by practice location, variation in responses were evident. Reported use of written breast cancer guidelines was less in both suburban (OR = 0.51) and urban areas (OR = 0.56) when compared to clinicians in rural areas. CONCLUSION: Development of an evidence-based consensus statement regarding breast cancer screening would support a single set of unambiguous guidelines for implementation in all primary care settings, thus decreasing variations in how breast cancer screening is approached across varied clinical settings.

Attitude of Health Personnel↗
PubMed1992

Pharmacoeconomics of the therapy of diarrhoeal disease.

We review the pathophysiology of intestinal water and electrolyte transport leading to diarrhoea, the currently available pharmacological strategies for its treatment, and the economic implications of such treatments. Diarrhoea occurs most frequently and is associated with highest mortality in children under 5. Oral rehydration therapy (ORT) is the cornerstone of its management. The safety and efficacy of ORT in the prevention of death from dehydration, both in field and also in hospital settings, are now well established. Because it is also inexpensive, ORT is widely applicable worldwide. More recently, rice-based ORT has emerged, based on well known traditional remedies for diarrhoea in southeast Asia and the Far East. Rice-based ORT has the advantage of being more culturally acceptable, readily available even in rural homes in developing countries, and is more effective in reducing stool output and the duration of diarrhoea, compared with conventional glucose-electrolyte solutions such as World Health Organization ORT. For infants, the well known antidiarrhoeal properties of human milk needs emphasis for a variety of reasons including economic ones. Data concerning the economic benefits to a nations' health budget as a result of nationwide implementation of oral rehydration solution (ORS) use are limited. Available data from individual centres in developing countries, if projected to national level, would incur considerable economic advantage. Except for a few notable infections such as shigellosis, cholera, amoebiasis and giardiasis, the widespread use of antibiotics in acute diarrhoea, still a common practice in many developing countries, has no proven value and may be detrimental. The economic implications of antibiotic abuse in the treatment of diarrhoea in developing countries is enormous. Despite the availability of a wide spectrum of pharmacological agents for diarrhoea reviewed in this article, only a few such agents are of proven clinical efficacy: corticosteroids, aminosalicylates and immunosuppressants in the treatment of inflammatory bowel disease and opioid derivatives such as loperamide which may be useful in protracted diarrhoea in children and in disorders where rapid gastrointestinal transit is the main cause of diarrhoea. Opioids are not recommended for acute infective diarrhoea in childhood. Octreotide, a somatostatin analogue, is reported to be useful in the treatment of secretory diarrhoea due to noninfective causes and in the treatment of intractable diarrhoea associated with AIDS. Its high cost and need for parenteral administration prevent its wider application.(ABSTRACT TRUNCATED AT 400 WORDS)

Adrenal Cortex Hormones↗
PubMed2006

Current and future water issues in the Oldman River Basin of Alberta, Canada.

Long-term trends in alpine and prairie snow pack accumulation and melt are affecting streamflow within the Oldman River Basin in southern Alberta, Canada. Unchecked rural and urban development also has contributed to changes in water quality, including enhanced microbial populations and increased waterborne pathogen occurrence. In this study we look at changing environment within the Oldman River Basin and its impact on water quality and quantity. The cumulative effects include a decline in net water supplies, and declining quality resulting in increased risk of disease. Our data indicates that decreases in the rate of flow of water can result in sedimentation of bacterial contaminants within the water column. Water for ecosystems, urban consumption, recreation and distribution through irrigation is often drawn from waterholding facilities such as dams and weirs, and concern must be expressed over the potential for contaminate build-up and disproportionate potential of these structures to pose a risk to human and animal health. With disruption of natural flow rates for water resulting from environmental change such as global warming and/or human intervention, increased attention needs to be paid to use of best management practices to protect source water supplies.

Alberta↗
PubMed1997

Tick-borne relapsing fever and pregnancy outcome in rural Tanzania.

OBJECTIVE: To assess the impact of tick-borne relapsing fever (TBRF) on the outcome of pregnancy. DESIGN: Case control study of 137 pregnant women (cases) and 120 non-pregnant women (controls) with TBRF between 1985 and 1995. SETTING: A rural hospital in Tabora Region, Tanzania. RESULTS: Risk of birth during the attack of TBRF was 58.0%, with an extremely high perinatal mortality of 436 per 1000 births. The total loss of pregnancies including abortions was 475. per 1000. Case-fatality rate in pregnant women was 1.5%, compared to 1.7% in the non-pregnant women. A Jarisch-Herxheimer reaction was seen in 1.5% of the cases and in 1.7% of controls. Relapse rate was 3.6%, compared to 1.7% in non-pregnant women. Pregnant women with TBRF show higher densities of spirochetes than non-pregnant women (p < 0.001). The risk of delivery during the attack was positively correlated to increasing density of the spirochetemia (p < 0.001) and to gestational age (p < 0.001). Perinatal death was related to low birthweight (p < 0.001) and low gestational age (p < 0.001) and not to degree of spirochetemia. CONCLUSIONS: The extremely high perinatal mortality rate during an attack asks for prevention and early effective management of TBRF. This is a challenge where access to health services in rural areas of developing countries is hampered by many factors.

Adult↗